Over-Regulation Has Criminalized The Practice Of Medicine

This criminalization of everyday life is not just insanely costly and insanely counter-productive--it's insanely punitive.

The average person has little exposure to the criminalization of everyday enterprise in America via over-regulation and outsized penalties for even accidental violations of rules and regulations. One field that continues to be burdened with excessive/counter-productive regulations and outsized penalties is the practice of medicine.

I received the following email from a physician correspondent:

"As you will see, physicians have to deal with the federal government's increasingly crazy and copious rules (like which patients they can screen for disease and how often).

The following is an email ad I received for an expensive service that provides no benefit to the ill and injured of America. It's bureaucratic nonsense."

Here is the email ad:

Can you afford a $1.1 million penalty and a 50-year exclusion from Medicare? That's what one New Jersey provider is facing. And he's not alone. In the last couple of months a facility in Utah is now under a 30-year exclusion, and a New York physician is now excluded from Medicare for five years.

These penalties and exclusions not only affect those providers that are intentionally fraudulent. Even an innocent mistake can land you in serious legal and financial hot water. Being tagged as "excluded" by the Office of the Inspector General (OIG) can crush your practice -- especially considering the new guidelines that went into effect just a couple of days ago (on Feb. 13th).

Tomorrow, a leading healthcare attorney will walk you through the new exclusionary rules that just took effect so that you can really understand what will keep you off of the OIG's hit list.

Here are just a few of the practical, easy-to-implement tactics you'll receive by attending this 60-minute online training:

--Determine specifically who you should screen (individuals and entities) and how often

--Avoid being placed on the list for lack of compliance if there is a match on your team

--Find out what other legal actions can have collateral damage resulting in exclusion

--Learn how to get reinstated onto Medicare after an exclusion period expires

--Head off the top "flags" that lead to exclusions

--Master documentation requirements making your files audit-proof

--And so much more...

To make matters worse, if you employ an excluded employee (even accidentally), any funds paid to them must be paid back to Medicare/Medicaid promptly, and if you don't take action quickly enough your entire practice could be at risk. Are you really ready to lose serious revenue by getting thrown out of Medicare and your other private insurers?

Don't take the chance. Invest just 60 minutes of your time and attend this step-by-step, plain-English online training session that will provide you with the tools you need to protect yourself, your staff and your practice. Don't wait, sign up today.

This is just the tip of the iceberg of healthcare compliance costs and penalties that are far more punishing that the "crimes." If you wonder why America pays the highest cost per person for uneven healthcare coverage and care, take a look at this chart of the administrative system that has mushroomed into an incredibly costly bureaucratic monster that provides zero care.

Add layer after layer after layer of new complex regulations to the practice of medicine, and soon enough you need millions of paper-pushing employees to monitor compliance, enforce compliance, pursue administrative and criminal charges of non-compliance, file claims and counter-claims, defend the innocent from false accusations, write hundreds of pages of new regulations, and so on.

Yes, there is a place for common-sense regulations, and procedures to vet caregivers and track standards of care, etc.

But the system is now so onerous and out of control that the practice of medicine now requires far more attorneys and compliance-regulatory-paper-pushers than it does doctors and nurses.

This is but one example of America's obsessive penchant for criminalizing and over-regulating everyday life. No wonder America has over 20 million people with felony convictions, many for drug-related offenses that should have been treated as medical conditions (such as addiction).

In America, every "crime" deserves a heavy and often-life-destroying penalty--even non-compliance "crimes" committed by overworked innocents.

This criminalization of everyday life is not just insanely costly and insanely counter-productive--it's insanely punitive. It is the output of a sick society, a sick culture and a sickness-unto-death system of governance.

Get a load of how you are scored just when you pick up a prescription on how PBMs predict if you will take your meds. Are you a man seeing a female MD, that's big ding right there...bogus algos created by Ingenix, the same subsidairy (now Optum Insights) being sued for Risk Fiddling in billing the government for Part D compensation.

This is why I stopped being in network with insurance companies and stopped billing insurance. If you bill the wrong code, they can put you in jail. The thing is, no one agrees on what the codes mean! You can ask several people and get several different answers. So, you are walking on a tightrope every day all day, wondering if you are using the wrong codes for each patients.

One of my patients was a nurse practitioner at one of the biggest hospitals in our city. After taking an insurance billing class, she said that if they were right, "all of them would be going to jail." They had been billing the "wrong" codes at a major hospital? What is the small time practitioner to do?

And patients don't get it. They want you to bill their insurance. At my peril. They lose nothing.

I know a guy who is billing the crap out of insurance. He is billing codes that I don't think are right. But, he is comfortable with it. He is super busy, because he bills insurance and is a good business person. He is taking a risk every day. He doesn't get it yet. The insurance companies could dispute every claim he ever made and was paid for, and GET ALL THEIR MONEY BACK! That is how it works. Years later they can claim every claim he made with that code will be "recouped."

Sir, I wish more doctors were like you and dumped insurance. I would LOVE to find a doctor that didn't take insurance, just charging a flat rate for office visits or did a "membership" thing like, say, Sam's Club. Congratulations for taking a stand.

When I billed insurance, I had to bill double my cash rate. Patients would sometimes get mad at me, but they didn't often get mad when their insurance company refused to pay me. They were unconcerned. If you don't bill insurance at twice your cash rate, you cannot cover the claims they refuse to pay, and the patients are long gone and unwilling or unable to pay.

It is all set up as a racket. They can get you on so many things if you bill insurance. They never get punished for putting people out of business when they don't pay. Somehow, that is all legal.

I used to have to submit my bills multiple times. Even with electronic billing. They would say they never received the claim.

One patient got mad at me because her insurance company paid me several times for certain claims. She thought I was double dipping. I pulled a report showing how many times I had to bill, and how many claims they still had not paid. After months! It was their fault for paying me twice for the same claim. I had to keep re-submitting to get paid at all.

I am now having insurance company flashbacks.

Once Blue Cross sent me a statement for claims for a patient that I never submitted. They do this regularly. People who are not even your patients! This patient was an old patient. I did not even have her Blue Cross member number to bill. I had not seen her in over a year! She got mad at me, thinking I was defrauding her insurance.

They always blame the practitioner. She could have easily filed a complaint against me to the medical board, saying I defrauded the insurance company. That would have been hellacious for me. Months of harassment. I finally convinced her I never submitted the bills. The codes billed were not even acupuncture codes.

It is such a horrible stress dealing with insurance. The average person has no idea what their provider does to just be paid for their work.

When I make a mistake, it is a "crime." When THEY make a mistake, it is all OK, and normal.

Once I had to wait 8 months to be paid by Blue cross. I kept re-submitting the bills. They finally paid me two to three times what they were supposed to. After waiting to be paid for 8 months, I figured I would just leave it. Otherwise they would take all the money back and I would start with square one.

My patient did not mind that I was not paid for 8 months. But she was really mad when they finally paid me so much money. She said I was getting rich at her expense. :(

I knew this would happen with Obamacare....overload the doctors with crap..and they will quit.....and they are...soon we will not have many to choose from...and many health issures will become killers....bad hip...forget about it..no more replacements...cancer...see ya buddy

Agreed. Physicians are over-regulated and drug companies are under-regulated. It seems that the government sees the purpose of physicians these days is to serve the drug companies, the insurance companies, the lawyers and homeland security. That is a sucky profession under such circumstances.

Parallels the rise of administration staff in higher education. The increase in those postions also correspond with interference by the Feds. Could it be the cost increases in healthcare and college are linked to the federal governments intrusion in both markets? Nah, that's not possible, we were promised the opposite would happen.

And it's not just health care. Do a Google on Accessibility Lawsuits in California and Texas. You'll find businesses being sued by individuals who have never visited those businesses for minor accessibility infractions like having square restrooms signs rather than round signs.

In Texas, hospitals recently received letters from an unethical attorney demanding $2000 each for website accessibility infractions even though his client had never sought services at those institutions. The letter includes a threat to get HHS involved jeopardizing their medicare and VA funding.

It's another example of well-intentioned regulation getting abused because of government failure to actually produce good law rather than issue executive branch regulations that are poorly defined and impossible to comply with.

the entire practice of american medicine is a joke. i am a case in point. i was diagnosed with pre type 2 diabetes, high blood pressure and high cholesterol. the first thing my doctor did was prescribes meds because that was the insurance protocol. i refused the meds which made me a noncompliant patient. compliance is a legal term, not a medical term. over the course of a year i got all my lab numbers back in line with a simple regime. i quit eating sugar(and sugar substitutes) and processed foods. the insurance company still considers me a noncompliant patient even though all my numbers are in line. so, ironically, because i healed myself using real medicine at a great savings to the national healthcare bill i am a doctor's pariah and have been treated that way ever since and my insurance company wants to raise my rates as a consequence. it's a fucked up system all the way around.

NEVER let a doctor do routine blood work. You can easily get it done yourself, and have the results sent directly to your email address. Once you identify any problems, it's generally pretty easy to get your numbers back in line, as you discovered.

You probably don't realize that the new Medicare (therefore also insurance) rules penalize the doctor, not you, if you are non-compliant and your lab tests don't improve.......so since most non compliant patients don't have as good an outcome as you had, it would be a good thing not to go back for blood work.

i know about the rules that make the doctor responsible for their patients' compliance with their med regime. again, it is a symptom of a misdirected system. there is no incentive(no money) in advising a client to eat well and get a little exercise. the major illness categories(perhaps even cancer) are a result of easily changeable lifestyle choices. it begins with diet and weight management. where is the incentive for a patient to make some lifestyle changes? i would propose that if the patients' numbers don't improve insurance premiums rise enough to pay for a gym membership and a dietician and maybe even a meditation teacher(for stress management). the doctor should have reimburement paid on a success quotient with the enforcement mechanism for noncompliance by the patient in the form of astronomical insurance premiums. people respond when it costs money not too. the blanket approach to insurance premiums has to go. the auto insurance business is an example that works. people drive safer because they know they will pay for their carelessness. the careless drivers pay for their carelessness. i really don't want my premiums to pay for your fat, unhealthy ass and the consequences of your affinity to sugary drinks and fast food.

Good luck getting a rational health insurance based on actuarial/other data or some such. One reason it'll never happen is because too many people agree with the Bernie Sanders idea that health care is a universal human right (no matter how fat you are).

dabnammit! you're not allowed to take personal responsibility. I suggest you have your attorney contact their attorney and offer a waiver to indemnify the HC provider and your Insurance provider. how inconsiderate! (sarc)

great experience. Health and being healthy has nothing to do with modern medicine. In fact as far away one is from modern medicine as healthy and long you can live. Despite enormous money spent in health care in US longest living americans are who don't see the doctors, don't eat american junk and don't speak english. Yes they are first generation spanish speaking hispanics who don't seek treatment, eat rice and beans from local bodege, don't eat and consume american processed food and shy of seeing doctors as most don't speak english. They outlive every ethenic group for about 2 years and don't consume tax dollars. Check out 'Hispanic paradox".

Incredulous that we have constructed such a FUBAR'd HC system with all the best and brightest. We could super impose the Catch-22 paradox to narrate the shear lunacy that all the HC industry's "Milo Minderbinders" have built. The beauty in all this fuckery is that for all the waste and inefficiencies, the cost burdens become a dynamic mutiplier effect driving returns on shareholders equity while the insureds get bombed up the ass. Oshitcare merely put lipstick on this godzilla beast. Repeal it? Hell no, burn it to the ground!

The physicians still mainly treat the patients that show up. The 'winners' in this are the H1B programmers who have to write a scheduling application to screen these patients, then write a billing application that submits bills to insurance companies who don't want to pay out anything!

Meanwhile, the old model of a nurse and doctor seeing a patient has added a compliance officer, safety inspector, IT support, biomedical equipment repair guy, business office clerk, bill coding clerk, etc

This is a growing problem. I deal with Medicare an the new MACRA-Mips guidelines which replace PQRS and other measures from prior years. I have also been in other parts of medicine for decades. I see the comments here and many are ignorant or the usual pessimist-conspiracy stuff. Some are on the money.

1. I do not know how most physicians keep from going insane these days. To run an office, keep up with changes from both private and government insurances while getting paid and paying your people a decent wage is a miracle. No one has to suffer the idiotic billing systems that comprises medicine. See if your plumber, lawyer, home builder or even GM"s accounting department have anything resembling the ICD-10 code and rules book. You can get certifications and college degrees in this stuff.

2. Medicine as practiced is not a scam. It is a science based art. All the meds, protocols, devices and therapies are based on testing with rigorous controls and solid statistical analyses. It is why we have the oldest and most sedentary population in all of world history. However, understand that your physician/s will have different skill levels that stem from not only training but their own practice and experiences. A lot of stuff I see as novel and curative is bullshit hype with no data. At best, it is based on theory. In medicine, most everything starts with observations, then a theory and then controlled interventions. BTW, they even often test "natural" therapies to see if there is merit.

3. YOU own your health. You partner with your doctor to achieve your goals. When he/she recommends something they are not trying to kill you or serving some secret cabal of interests that works against your health. They want a good outcome just like you do. When you go against their recommendations do so with some humility and take responsibility. I have done that myself. It is why I still have a gallbladder today despite three recommendations to take it out. You can go herbal, Eastern, naturopathic, chiropractic, or anything else you want. You take responsibility for it, let your doctor know (if you are working with one). Just don't go overboard with the evil doctor thing.

4. The industrialization and complicating of medicine is changing the relationship with physicians. If your doc is an employee they may well be on "production". They need to see four or possibly more patients per hour to either earn his/her salary or make the practice pay enough. That is why there is rarely time for a nice chat.BTW, it applies to your pharmacist, as well.

5. Everyone feels a right to intervene in medicine. Just because you make an awesome steak at home or buy one at a restaurant does not mean you know anything about running a great steakhouse. Obama, Hillary or most government types do not know shit about medicine but are sure they know how to "fix" it. They don't even measure the right things to know how to fix it. Medicare puts out complex vague rules that are hard to follow but can result in penalties or bonuses to meet goals. I do not have time to explain it but just know that many of the cost and wellness measures and bonuses are the very things that get you thrown out of the practice if you are sicker than average or do not comply with the therapy. A sick noncompliant patient can blow the cost curves for the doctor. This is a function of endless interventions and systems that drive practices.

6. Most doctors just want to practice good medicine and get paid reasonably simply and well. They do want to help you get better but it is a nightmare of complexity and rules. Everyone from the DEA to Medicare auditors is watching, intervening and creating new rules.

I could write more but I am tired and long posts are generally dull. It is fair to question most anything including the practice of medicine but I tire of the arrogance of people who don't know anything and write arrogantly. That actually supports elitism by know-nothings.

Do what you think is best for yourself but you do not simultaneously have to assume everyone outside of your choice is evil or corrupt.

The Rise of the Quants, Again! This Time In US Healthcare- Taming the Macra Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True
I’ve been watching this for
This post is for you....quantitated madness indeed!
http://ducknetweb.blogspot.com/2016/05/the-rise-of-quants-again-this-tim...
We need to get rid of the United Healthcare incest that created all these models in the last 8 years running HHS and CMS.

Grossly overreacting, here. THAT'S A SALES PITCH, YOU DUMBASS. Just like the fly-by-night "whole body scanners" who prowl the country offering seniors a half-dozen unnecessary diagnostic scans (which, remember, involve radiation exposure) for the low, low price of $200, that flyer is intended to stampede legally-ignorant practices into the belief that they're going to lose their shirts if they don't PAY to keep up with the regulations. In fact, federal regulators are very, very accomodating to medical practices and hardly ever investigate them unless they have evidence of egregious Medicare frauds (and often not even then). So RELAX. Yes, there are too many regulations in medicine and nobody likes them, BUT . . . you aren't going to lose your practice because of them unless you really, really do something you know is wrong. Mostly you'll just be nattered to death when you could be taking care of patients.

I've worked in this field, enforcing regs, keeping doctors out of trouble, and helping lawyers on both sides. This article is a tempest in a teakettle.